In the last few years, Ambulatory Surgical Centres (ASC) has become one of the fastest-growing medical services. However, the ASC billing and coding is different from the physician, surgeon, or hospital billing. Hence, the billing department of an ASC facility has to be aware of the various guidelines that Medicare often uses compared to the other payers. Furthermore, different payers differ regarding the approved procedures, medical necessity, and other requirements for filling out the forms for reimbursement.
The lack of awareness of all these and the regular updates published by CMS every quarter on the lists of surgical procedures covered, the ancillary services covered for establishing payment indicators, and payment rates can be challenging for ASC billing. Added to this, the newly created Category III CPT codes and Level II HCPCS make the billing and coding process difficult, resulting in some common ASC billing errors.
For any ASC practice, it is essential to know these five common errors with ASC Billing to ensure they do not lose out on revenue. Here is a list of five errors that mostly happens in ASC billing.
1. Lack of Understanding of the Managed Care Contract
The biller of your facility must understand in detail and have a copy of all the managed care contracts. The knowledge of the contract must include:
- The time you will get for submitting the claim
- How long the payer will take to review the claim and make the payment
- What is the methodology of payment?
- When and why a payer can reduce the payment and reduce multiple procedures
- How to appeal the claim that has been denied or rejected.
The knowledge of all these and post payments and follow-up can improve your revenue cycle management. For instance, when you know the managed care contract in detail, you can avoid taking an implant case that would charge $3,000 when the carrier won’t reimburse the implant more than $2,000.
Understanding the ins and outs of the contract can help your ASC facility be a more profitable centre where you are aware of the procedures that can be carried out with successful reimbursements.
2. Medicare and the SNF Condition
Even when you have all the proper paperwork, you need to know the Skilled Nursing Facility (SNF). Medicare will refuse to reimburse for any ASC services conducted within the SNF. The patient will not get any reimbursement for treatment in such a case, so be aware of the SNFs in the area before you take the patient in.
3. Getting Appropriate Authorization & Verification
Before conducting a procedure, you need to understand the coverage a patient receives and determine the party’s responsibility. Part of it also includes verifying the edibility of the claim and the address of the claim.
Failure to get the verification and the appropriate authorization often results in reimbursement delays. Hence, all the paperwork must be done before undertaking the correct procedures and ensuring whether costly implants are covered.
In the case of working with out-of-network carriers, the failure to ask specific questions, like the reimbursement amount, can result in a loss of profitability for the case. Also, it is necessary to conduct pre-negotiation coverage with the carrier for any uncovered procedures and get the commitment in writing. Unless it is written down, the chances are you won’t get paid for it.
4. Non-HIPAA Carriers
Like any other healthcare service provider, ASC also depends on standardized codes set by Medicare and CPA to get paid. However, several non-HIPAA carriers will not pay you when Medicare standardized codes are used. Therefore, you need to know the codes of these small carriers exempt from HIPAA so your reimbursement is not rejected.
5. Coding Errors
One of the top five reasons ASC claims get rejected is wrong coding and the failure to put the correct codes in order. When you put codes in the bill, always ensure to place the highest reimbursement code and then gradually lower it. If there is any cut on the second or following code reimbursement, you would like to get it for a lower reimbursement amount than the higher one. For instance, if there are two codes in the bill, one for $1,000 and another for $500, where the second procedure will get paid half in the list, you would want the cut on $500 instead of $1,000.
The wrong coding between the surgeon and ASC would result in procedure discrepancies, leading to claim denial or rejection. Both the ASC billing staff and the surgeon must be on the same page and have proper knowledge and education on the current ASC coding.
How to Deal with these Errors?
Undoubtedly, there are many ASC who have dedicated billing departments and staff. But the complicated billing procedures with the ever-changing codes and regulations put a question mark on their revenue. In such a case, the best way to beat these errors and any pitfalls in ASC billing is by partnering with the experts of 24/7 Medical Billing Services.
This outsourced Ambulatory Surgical Centres billing company has a specialized and dedicated ASC billing staff who can help overcome these common errors with ASC Billing and put the best revenue management cycle in place for improving the practice’s outcome.
Read more: All You Want To Know About ASC Billing